The Last Peace

IMAGINE

The Last Peace:Identifying the barriers and facilitators to achieving a home death and how these can be addressed

Who are we?5th year medical students:

Aaniya Ahmed, Shiraz Jamshaid, Doa’a Kerwat, Folashade Oyewole, Dina Saleh, Meelad Sayma, Samad Wahid

The Problem

Office for National Statistics 2015 (UK)

would like to die at home

81% 23%

do die at home

Aims

1. Identify the barriers and facilitators to achieving home as a place of death in the UK

2. Address the barriers and facilitators to achievinghome as a place of death in the UK

Definitions

Barrier – factors preventing or deterring patients from dying at home

Facilitator – allowing or encouraging patients to die at home

Study Outline

SYSTEMATIC LITERATURE

REVIEW

PRIMARY DATA STUDY

DISCUSSION OF FINDINGS

Aim 1: Identify

Aim 2: Address

IMPLICATIONS TO RESEARCH

IMPLICATIONS TO PRACTICE

Systematic Literature Review

5 3241 72Databases Initial Papers Papers

Analysed

37 Qualitative

Quantitative

1

34

Mixed Methods

Objective 1: Systematic Literature Review

Systematic Literature Review

37 META-ETHNOGRAPHY

34DESCRIPTIVE ANALYSIS

Qualitative

Quantitative

Objective 1: Systematic Literature Review

Systematic Literature Review:Results

Stakeholders Lack

Knowledge

Social Factors

Family Burden

Poor Discharge

Patient Condition

Poor Planning

6 BARRIERS

4 FACILITATORS

Effective Communication

Skilled Staff & Carers

Coordinated Care

Patient Support

DiscussionLiterature

Review

Overall project

discussion

Primary Data

Study Outline

SYSTEMATIC LITERATURE

REVIEW

PRIMARY DATA STUDY

DISCUSSION OF FINDINGS

Aim 1: Identify

Aim 2: Address

IMPLICATIONS TO RESEARCH

IMPLICATIONS TO PRACTICE

Primary Data Collection:Semi-structured interviews

Hospital CommunityPolicy &

Academia

33

Primary Data Collection:Semi-structured interviews

33Doctors

Formal Caregivers

Discharge Coordinators

Nurses

Hospice Staff

ProfessorsPolicy Makers

Palliative Care

Oncology

Charity Staff Geriatrics

Primary Data Collection:Semi-structured interviews

33

Institute of Global Health & Innovation

Objective 2: Primary Data Collection

Education

Planning

Managing People

Primary Data Results:

Study Outline

SYSTEMATIC LITERATURE

REVIEW

PRIMARY DATA STUDY

DISCUSSION OF FINDINGS

Aim 1: Identify

Aim 2: Address

SOLUTION DEVELOPMENT

IMPLICATIONS TO RESEARCH

IMPLICATIONS TO PRACTICE

DiscussionLiterature

Review

6 Barriers4 Enablers

Primary Data

10 ActionPoints

6 Overarching Barriers

Objective 3: Discussion of Findings

Fear, stigma & burden of

death

Barrier 1:

ACTION POINT 1: Acknowledge and address this fear

Patient Specific Discrepancies

Barrier 2:

ACTION POINT 2: Identify disadvantaged groups that need further support

Communication DifficultiesBarrier 3:

ACTION POINT 3: Encourage communication to elicit patient preferences

Knowledge DeficitBarrier 4:

ACTION POINT 4: Equip stakeholders with the knowledge of EoLC

Resource Allocation Challenges

Barrier 5:

ACTION POINT 5: Evaluate efficiency of current resource allocation

Poor Planning

Barrier 6:

ACTION POINT 6: Carrying out end to end planning of EoLC

6 Barriers

Patient Specific Discrepancies

Knowledge Deficit

Resource Allocation Challenges

Fear, Stigma and Burden Communication

Poor Planning

Overarching 4 Facilitators

Well DocumentedWishes

Facilitator 1:

ACTION POINT 7: Document wishes as early as possible

Effective SupportFacilitator 2:

ACTION POINT 8: Ensure strong EoLC support

Early RecognitionFacilitator 3:

ACTION POINT 9: Recognise patients in need of end-of-life care early

Seamless Hospital & Community and

Coordination

Facilitator 4:

ACTION POINT 10: Coordinate Services

Well Documented Wishes

4 Facilitators

Early Identification

Seamless Hospital &

Community Coordination

Effective Support

10 Action Points1) Acknowledge fear

2) Identify the disadvantaged

3) Encourage communication

4) Equip stakeholders withknowledge

6) End to end planning

5) Evaluate efficiency of resources

7) Document wishes early

8) Emphasis training

9) Recognise patients early

10) Coordinate services

Study Outline

SYSTEMATIC LITERATURE

REVIEW

PRIMARY DATA STUDY

DISCUSSION OF FINDINGS

Objective 1: Identify

Objective 2: Address

IMPLICATIONS TO RESEARCH

IMPLICATIONS TO PRACTICE

What does this mean?

IMPLICATIONS TO RESEARCH

More investigation?

?

??

?• Drivers underlying the fear of death?

• Differences in dying at home between cancer and non-cancer patients?

• Identify the extent of the 6 barriers and 4 facilitators

Objective 4: Implications to Research

Study Outline

SYSTEMATIC LITERATURE

REVIEW

PRIMARY DATA STUDY

DISCUSSION OF FINDINGS

Objective 1: Identify

Objective 2: Address

IMPLICATIONS TO PRACTICE

IMPLICATIONS TO RESEARCH

What can we do?

IMPLICATIONS TO PRACTICE

Objective 5: Implications to practice

Who does the problem affect?

Patients Families Carers

33

HCPs

PROBLEM 1:

DOCTORS LACK SKILLS & CONFIDENCE

HEALTH CARE PROFESSIONALS

◉ Reviewed curriculum◉ Lack of teaching on EoLC

◉ Surveyed 87 Medical Students

RECOMMENDATION 1: MEDICAL EDUCATION

Only 7% feel confident

This is SO

exciting!

?

PROBLEM 2:

PEOPLE DON’T LIKE TALKING ABOUT END

OF LIFE

HOW CAN WE CHANGE THAT?

RECOMMENDATION 2: MARKETING

The Attachment-Aversion Model

Increase motivation by appealing to:

◉ Self Relevance◉ Aesthetic Needs◉ Functional Needs◉ Spiritual Needs

A. B. Eisingerich & Park et al 2013

FIND IT:

Ever given any thoughts about your end of life care wishes?

No?

Don’t leave it ‘til it’s too late, make a plan today.

Visit www.missingpeace.com

RECOMMENDATION 3:

COMMENCE ACP AS EARLY AS POSSIBLE

RECOMMENDATION 4: EDUCATION AND TRAINING IN END-OF-LIFE CARE FOR INFORMAL CARERS

RECOMMENDATION 5:

ADOPTING BEST PRACTICE IN DISCHARGE

Study Outline

SYSTEMATIC LITERATURE

REVIEW

PRIMARY DATA STUDY

DISCUSSION OF FINDINGS

Objective 1: Identify

Objective 2: Address

IMPLICATIONS TO RESEARCH

IMPLICATIONS TO PRACTICE

10 Action Points1) Acknowledge fear

2) Identify the disadvantaged

3) Encourage communication

4) Equip stakeholders withknowledge

6) End to end planning

5) Evaluate efficiency of resources

7) Document wishes early

8) Emphasis training

9) Recognise patients early

10) Coordinate services

“

Thank You